Salvage Therapy with Bicalutamide 150mg and Tamoxifen in Patients with Rapidly Rising PSA After Radical Prostatectomy
CUA Online Library. alesawi a. 06/22/13; 31404; UP-25
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Abstract
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Objective: To describe long-term outcomes of bicalutamide 150 mg plus
tamoxifen 20 mg once daily as a treatment for nonmetastatic biochemical
recurrence after radical prostatectomy (RP), and to identify prognostic risk factors
of treatment failure.
Methodology: This single center, retrospective study included 67 prostate cancer
(PCa) patients treated with RP who had a rapidly rising PSA recurrence. Patients
were informed that LHRH is the standard therapy but elected to be treated with
daily bicalutamide 150 mg plus tamoxifen 20 mg (to minimize gynecomastia) to
preserve their quality of life and libido. Response was de ned as positive
(decline or stable PSA) or negative (PSA increase). The duration of response is
the time from starting treatment to rst PSA rise after reaching nadir.
Results: The mean PSA at start of treatment was 1.43±1.41 ng/mL. The mean
duration of treatment was 40.12 ± 25.36 months and the median was 37 months.
Of this group, 46 patients reached undetectable PSA. The duration of treatment
with bicalutamide was 46.7 ± 24 months for the complete responders (who
reached undetectable PSA levels) compared to 25.7 ± 22.5 months for those that
did not reach undetectable PSA (p= 0.0012). Analyses were performed to correlate
the duration of response with various baseline parameters such as stage, Gleason
score, margin status, nodal status and PSA at the start of treatment. Clinical stage
and Gleason grade were signi cantly correlated with duration of treatment and
response: of the 13 patients with Gleason 6, the mean duration was 57 ± 23.9
months compared to 36 ± 24.2 months for the 54 patients with Gleason 7
(p=0.0066). Patients who reached to undetectable PSA levels (46 patients) had a
mean PSA level of 1.21 ±1.11 ng/ml at the start of treatment compared to
1.9 ±1.86 ng/ml for those (21 patients) who did not reached to undetectable
PSA levels (p=0.063). The main side e ect was hot ushes (52.2 %) which were
managed by reduction of the tamoxifen dose.
Conclusions: Bicalutamide 150 mg plus tamoxifen 20 mg is an e ective treatment
for biochemical recurrence after RP for men wishing to minimize the side e ects
of LHRH therapy. Our results indicate that patients with Gleason 6 and/or a lower
PSA level at the start of bicalutamide treatment will have a longer duration of
positive response.
tamoxifen 20 mg once daily as a treatment for nonmetastatic biochemical
recurrence after radical prostatectomy (RP), and to identify prognostic risk factors
of treatment failure.
Methodology: This single center, retrospective study included 67 prostate cancer
(PCa) patients treated with RP who had a rapidly rising PSA recurrence. Patients
were informed that LHRH is the standard therapy but elected to be treated with
daily bicalutamide 150 mg plus tamoxifen 20 mg (to minimize gynecomastia) to
preserve their quality of life and libido. Response was de ned as positive
(decline or stable PSA) or negative (PSA increase). The duration of response is
the time from starting treatment to rst PSA rise after reaching nadir.
Results: The mean PSA at start of treatment was 1.43±1.41 ng/mL. The mean
duration of treatment was 40.12 ± 25.36 months and the median was 37 months.
Of this group, 46 patients reached undetectable PSA. The duration of treatment
with bicalutamide was 46.7 ± 24 months for the complete responders (who
reached undetectable PSA levels) compared to 25.7 ± 22.5 months for those that
did not reach undetectable PSA (p= 0.0012). Analyses were performed to correlate
the duration of response with various baseline parameters such as stage, Gleason
score, margin status, nodal status and PSA at the start of treatment. Clinical stage
and Gleason grade were signi cantly correlated with duration of treatment and
response: of the 13 patients with Gleason 6, the mean duration was 57 ± 23.9
months compared to 36 ± 24.2 months for the 54 patients with Gleason 7
(p=0.0066). Patients who reached to undetectable PSA levels (46 patients) had a
mean PSA level of 1.21 ±1.11 ng/ml at the start of treatment compared to
1.9 ±1.86 ng/ml for those (21 patients) who did not reached to undetectable
PSA levels (p=0.063). The main side e ect was hot ushes (52.2 %) which were
managed by reduction of the tamoxifen dose.
Conclusions: Bicalutamide 150 mg plus tamoxifen 20 mg is an e ective treatment
for biochemical recurrence after RP for men wishing to minimize the side e ects
of LHRH therapy. Our results indicate that patients with Gleason 6 and/or a lower
PSA level at the start of bicalutamide treatment will have a longer duration of
positive response.
Objective: To describe long-term outcomes of bicalutamide 150 mg plus
tamoxifen 20 mg once daily as a treatment for nonmetastatic biochemical
recurrence after radical prostatectomy (RP), and to identify prognostic risk factors
of treatment failure.
Methodology: This single center, retrospective study included 67 prostate cancer
(PCa) patients treated with RP who had a rapidly rising PSA recurrence. Patients
were informed that LHRH is the standard therapy but elected to be treated with
daily bicalutamide 150 mg plus tamoxifen 20 mg (to minimize gynecomastia) to
preserve their quality of life and libido. Response was de ned as positive
(decline or stable PSA) or negative (PSA increase). The duration of response is
the time from starting treatment to rst PSA rise after reaching nadir.
Results: The mean PSA at start of treatment was 1.43±1.41 ng/mL. The mean
duration of treatment was 40.12 ± 25.36 months and the median was 37 months.
Of this group, 46 patients reached undetectable PSA. The duration of treatment
with bicalutamide was 46.7 ± 24 months for the complete responders (who
reached undetectable PSA levels) compared to 25.7 ± 22.5 months for those that
did not reach undetectable PSA (p= 0.0012). Analyses were performed to correlate
the duration of response with various baseline parameters such as stage, Gleason
score, margin status, nodal status and PSA at the start of treatment. Clinical stage
and Gleason grade were signi cantly correlated with duration of treatment and
response: of the 13 patients with Gleason 6, the mean duration was 57 ± 23.9
months compared to 36 ± 24.2 months for the 54 patients with Gleason 7
(p=0.0066). Patients who reached to undetectable PSA levels (46 patients) had a
mean PSA level of 1.21 ±1.11 ng/ml at the start of treatment compared to
1.9 ±1.86 ng/ml for those (21 patients) who did not reached to undetectable
PSA levels (p=0.063). The main side e ect was hot ushes (52.2 %) which were
managed by reduction of the tamoxifen dose.
Conclusions: Bicalutamide 150 mg plus tamoxifen 20 mg is an e ective treatment
for biochemical recurrence after RP for men wishing to minimize the side e ects
of LHRH therapy. Our results indicate that patients with Gleason 6 and/or a lower
PSA level at the start of bicalutamide treatment will have a longer duration of
positive response.
tamoxifen 20 mg once daily as a treatment for nonmetastatic biochemical
recurrence after radical prostatectomy (RP), and to identify prognostic risk factors
of treatment failure.
Methodology: This single center, retrospective study included 67 prostate cancer
(PCa) patients treated with RP who had a rapidly rising PSA recurrence. Patients
were informed that LHRH is the standard therapy but elected to be treated with
daily bicalutamide 150 mg plus tamoxifen 20 mg (to minimize gynecomastia) to
preserve their quality of life and libido. Response was de ned as positive
(decline or stable PSA) or negative (PSA increase). The duration of response is
the time from starting treatment to rst PSA rise after reaching nadir.
Results: The mean PSA at start of treatment was 1.43±1.41 ng/mL. The mean
duration of treatment was 40.12 ± 25.36 months and the median was 37 months.
Of this group, 46 patients reached undetectable PSA. The duration of treatment
with bicalutamide was 46.7 ± 24 months for the complete responders (who
reached undetectable PSA levels) compared to 25.7 ± 22.5 months for those that
did not reach undetectable PSA (p= 0.0012). Analyses were performed to correlate
the duration of response with various baseline parameters such as stage, Gleason
score, margin status, nodal status and PSA at the start of treatment. Clinical stage
and Gleason grade were signi cantly correlated with duration of treatment and
response: of the 13 patients with Gleason 6, the mean duration was 57 ± 23.9
months compared to 36 ± 24.2 months for the 54 patients with Gleason 7
(p=0.0066). Patients who reached to undetectable PSA levels (46 patients) had a
mean PSA level of 1.21 ±1.11 ng/ml at the start of treatment compared to
1.9 ±1.86 ng/ml for those (21 patients) who did not reached to undetectable
PSA levels (p=0.063). The main side e ect was hot ushes (52.2 %) which were
managed by reduction of the tamoxifen dose.
Conclusions: Bicalutamide 150 mg plus tamoxifen 20 mg is an e ective treatment
for biochemical recurrence after RP for men wishing to minimize the side e ects
of LHRH therapy. Our results indicate that patients with Gleason 6 and/or a lower
PSA level at the start of bicalutamide treatment will have a longer duration of
positive response.
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